The value of trichoscopy in the follow-up care of patients with androgenetic alopecia

The Value of Trichoscopy in the Follow-up Care of Patients with Androgenetic Alopecia 4Androgenetic alopecia requires a long-term, and even life-long continuation of nonsurgical therapy, and thus necessitates the follow-up of treatment efficacy using objective methods. TrichoScan is currently the most successful method adopted for this purpose. On the other hand, it is a paid software, it takes time to process and only works with certain brand videodermoscopes and hand dermoscopes. Therefore, there is a need for more easy-to-apply, inexpensive, quick and as well as reliable method. Trichoscopy has been used successfully for the diagnosis of various types of alopecia, however its value in follow-up care of patients with androgenetic alopecia is yet unknown. In this study, we aimed to evaluate the trichoscopic findings before and after treatment in patients diagnosed with androgenetic alopecia, compare the findings with the results of a TrichoScan software analysis, and determine the value of trichoscopy in the follow-up care of patients with AGA. This prospective study included 95 patients who were diagnosed with androgenetic alopecia based on clinical and trichoscopic examinations.The hairs in a 1 cm2 circular area in the left frontoparietal region were cut to a length of 0.5–1 mm. Trichoscopic images were acquired before treatment in all and at the end of 3 months of treatment in 61 patients. The images were evaluated by two physicians, one with less experience (physician A) and the other with broad experience (physician B) in hair diseases and trichoscopy. Physician A evaluated the images twice. The total number of hairs, the number of terminal and vellus hairs, and the ratio of terminal to vellus hairs were determined. The same numerical data was calculated also with TrichoScan analysis. The numerical data obtained by the two physicians were compared with those obtained using the TrichoScan software. The agreement between physician A and TrichoScan prior to treatment was moderate for the number of terminal hairs and the total number of hairs (CCC=0.9443, 95% CI, 0.9179–0.9624; CCC=0.9412, 95% CI, 0.9131–0.9604, respectively) and good post-treatment (CCC=0.9755, 95% CI, 0.9602–0.9849; CCC=0.9631, 95% CI, 0.9403–0.9773). Agreement for the number of vellus hairs (CCC=0.8199, 95% CI, 0.7433–0.8752; CCC=0.8974, 95% CI, 0.8366–0.9364, respectively) and the terminal to vellus hair ratio (CCC=0.8161, 95% CI, 0.7395–0.8718, CCC=0.8719, 95% CI, 0.7989–0.9195, respectively) both before and after treatment was poor. The agreement between physician B and TrichoScan both before and after treatment was excellent for the number of terminal hairs (CCC=0.996, 95% CI, 0.9944–0.9975; CCC=0.9991, 95% CI, 0.9985–9994, respectively), the number of vellus hairs (CCC=0.990, 95% CI, 0.9862–0.9938; CCC=0.9948, 95% CI, 0.9914–0.9968, respectively) and the total number of hairs (CCC=0.9971, 95% CI, 0.9956–0.9980; CCC=0.999, 95% CI, 0.9984–0.9994, respectively) and good for terminal to vellus hair ratio (CCC=0.9734, 95% CI, 0.9607–0.9821, CCC=0.9875, 95% CI, 0.9793–0.9925). Trichoscopy can be used as a sensitive method in the follow-up care of patients with androgenetic alopecia, based on the determination of the number of terminal hairs, the number of vellus hairs, the total number of hairs and the terminal to vellus hair ratio, when performed by a physician with experience in hair diseases and trichoscopy.